Fixation of the short-term central venous catheter. A comparison of two techniques

Abstract Purpose: To compare the fixation of the central venous catheter (CVC) using two suture techniques. Methods: A clinical, analytical, interventional, longitudinal, prospective, controlled, single-blind and randomized study in adult, intensive care unit (ICU) patients. After admission and indication of CVC use, the patients were allocated to the Wing group (n = 35, catheter fixation with clamping wings and retainers) or Shoelace group (n = 35, catheter fixation using shoelace cross-tied sutures around the device). Displacement, kinking, fixation failure, hyperemia at the insertion site, purulent secretion, loss of the device, psychomotor agitation, mental confusion, and bacterial growth at the insertion site were evaluated. Results: Compared with the Wing group, the Shoelace group had a lower occurrence of catheter displacement (n=0 versus n =4; p = 0.04), kinking (n=0 versus n=8; p=0.001), and fixation failure (n=2 versus n=8; p=0.018). No significant difference was found in bacterial growth (n=20 versus n=14; p=0.267) between groups. Conclusion: The Shoelace fixation technique presented fewer adverse events than the Wing fixation technique.

Antimicrobial activity of Calendula officinalis, Camellia sinensis and chlorhexidine against the adherence of microorganisms to sutures after extraction of unerupted third molars

OBJECTIVE: The objective of this study was to compare the antimicrobial effect of mouthwashes containing Calendula officinalis L., Camellia sinensis (L.) Kuntze and 0.12 percent chlorhexidine digluconate on the adherence of microorganisms to suture materials after extraction of unerupted third molars. MATERIAL AND METHODS: Eighteen patients with unerupted maxillary third molars indicated for extraction were selected (n=6 per mouthwash). First, the patients were subjected to extraction of the left tooth and instructed not to use any type of antiseptic solution at the site of surgery (control group). After 15 days, the right tooth was extracted and the patients were instructed to use the Calendula officinalis, Camellia sinensis or chlorhexidine mouthwash during 1 week (experimental group). For each surgery, the sutures were removed on postoperative day 7 and placed in sterile phosphate-buffered saline. Next, serial dilutions were prepared and seeded onto different culture media for the growth of the following microorganisms: blood agar for total microorganism growth; Mitis Salivarius bacitracin sucrose agar for mutans group streptococci; mannitol agar for Staphylococcus spp.; MacConkey agar for enterobacteria and Pseudomonas spp., and Sabouraud dextrose agar containing chloramphenicol for Candida spp. The plates were incubated during 24-48 h at 37ºC for microorganism count (CFU/mL). RESULTS: The three mouthwashes tested reduced the number of microorganisms adhered to the sutures compared to the control group. However, significant differences between the control and experimental groups were only observed for the mouthwash containing 0.12 percent chlorhexidine digluconate. CONCLUSIONS: Calendula officinalis L. and Camellia sinensis (L.) Kuntze presented antimicrobial activity against the adherence of microorganisms to sutures but were not as efficient as chlorhexidine digluconate.

Queratopatía cristalina: diagnóstico clínico y microbiológico de una infección corneal infrecuente causada por el grupo Streptococcus mitis

El objetivo del presente informe es describir un caso de queratopatía cristalina causada por microorganismos pertenecientes al grupo Streptococcus mitis en una paciente que concurrió a la consulta oftalmológica por molestias en su ojo derecho. Al examen oftalmológico presentó un punto de sutura interrumpida de nylon 10-0 sin tensión y con secreciones mucosas adheridas. El punto flojo fue retirado bajo normas de asepsia. Se indicó colirio de moxifloxacina al 0,5 %; el ojo tuvo una evolución adecuada, con una correcta epitelización. Sin embargo, luego de 15 días desarrolló un infiltrado blanquecino arboriforme. Se tomó una muestra en el quirófano, enhebrando el trayecto intraestromal de la sutura retirada con sutura de vicryl 7-0. Se indicaron colirios de vancomicina con 50 mg/ml. El infiltrado se mantuvo estable durante 45 días, luego se incrementó el tamaño y se produjo necrosis tisular con peligro de perforación corneal. Se realizó un recubrimiento conjuntival bipediculado. La paciente evolucionó favorablemente y luego de la retracción espontánea del recubrimiento, se observó leucoma cicatrizal y neovasos corneales.

Crystalline keratopathy: an infrequent corneal infection produced by the Streptococcus mitis group. The objective of this report is to describe a case of crystalline keratopathy caused by the Streptococcus mitis group corresponding to a patient who attended hospital for discomfort in his right eye. The ophthalmological examination showed an interrupted stitch of 10-0 nylon suture without tension and with attached mucus secretions. The loose suture was removed under aseptic conditions. Moxifloxacin 0.5 % eye drops were topically indicated. The treated eye successfully epithelialized and evolved favorably. However, after 15 days, a white tree-shaped infiltrate developed. A corneal sample was taken in the operating room, threading the intrastromal path of the removed stitch with a 7-0 vicryl suture. Vancomycin 50 mg/ml drops were indicated. The infiltrate, which was stable for 45 days, later increased its size and tissue necrosis occurred with danger of corneal perforation. A bipedicle conjunctival flap was performed in the affected corneal area, which evolved favorably. After spontaneous conjunctival flap retraction, only corneal scarring and neovascularization outside the visual axis were observed.

randomized controlled trial comparing the use of prolene suture and nylon tape in modified Shirodkar operation: a clinical-microbiological study

A short cervix during pregnancy offers less resistance to ascending infection, which is related to the occurrence of preterm birth, preterm premature rupture of the membranes, and mid-trimester abortion. All these events significantly increase the incidence of perinatal mortality and morbidity. Cervical cerclage is a procedure used to increase the functional length of the cervix during pregnancy, by placement of a tape at the level of the internal os to support the cervical musculature. Much controversy is present about the value of cervical cerclage in improving perinatal outcome. The use of a braided synthetic material, that will significantly change the bacterial milieu in the upper vagina and cervix, might in itself play a role in promoting infection, and might contribute to this controversy. On the other hand, the use of a monofilament suture material as Prolene, might obviate the changes in the bacterial milieu of the high vagina after the procedure, and might help improve the perinatal outcome. To identify the microbiological changes of the cervico-vaginal flora in women undergoing modified Shirodkar operation using two different suture materials, and to compare the pregnancy outcomes as an indicator of operation effectiveness. A randomised controlled trail was conducted at Ain Shams University Maternity Hospital [ASUMH] from September 2000 through February 2002. Bacteriological indicators of infection [Number and type of colony forming units]; fetal salvage ratio; prematurity ratio. 44 Cases with clinical and/or dynamic ultrasonographic criteria of cervcial incompetence underwent cervical cerclage operation using either Prolene suture or Nylon-tape according to the modified Schirodkar technique. 4 cases dropped out. The rest [40 cases] were followed up till they ended their pregnancy spontaneously. Bacteriological swabs were obtained pre- and 4 weeks post operatively and aerobic and anaerobic cultures were performed and analysed. No difference was observed between the two groups in any of the major confounding variables. The Prolene group had statistically significantly less post-operative bacterial colonizaton compared to the Nylon-tape group. The Prolene group showed better fetal-salvage and prematurity ratois; the results reaching statistical significance. Elective cervical cerclage by modified Shirodkar technique at 12 to 18 weeks' gestation using Prolene suture improves the fetal salvage as well as the prematurity ratio in patients at risk of fetal wastage due to cervical incompetence. Prolene suture was statistically significantly superior to Nylon tape as regards the microbiological and perinatal outcome measures. Intervention on the basis of dynamic ultrasono graphic parameters was related to a better fetal survival outcome

Análise histológica e microbiológica de três fios de sutura usados na cavidade bucal de humanos / Histological and microbiological study of three suture threads utilized in human oral cavity

Este trabalho objetivou estudar o comportamento da gengiva alveolar de quatro pacientes frente aos fios de sutura de poliéster siliconizado, poligliconato, polibutéster e a interferência das bactérias que aderem ao fio no processo de reparaçäo. Os resultados revelaram que o fio de polibutéster foi o que provocou reaçäo inflamatória de menor intensidade e com processo reparativo mais precoce. O fio de poligliconato foi o que provocou reaçäo inflamatória mais intensa. Já o fio de polibutéster foi o que permitiu menor aderência bacteriana na superfície

Efeitos da antissepsia com clorexidina sobre o crescimento bacteriano em suturas com fio de algodäo: estudo microbiológico e histomorfológico em ratos / Effects of antisepsis with chlorhexidine on the bacteria growth in cotton suture: a microbiological and histomorphologic study in rats

Neste trabalho, foi avaliada a ação da clorexidina sobre as bactérias que podem estar aderidas ao fio de algodão (multifilamentar) utilizado na sutura da mucosa gengival após extração dental. Foram empregados 18 ratos divididos em 3 grupos com os seguintes procedimentos experimentais: No grupo I (clorexidina), após antissepsia da mucosa gengival com clorexidina, o incisivo superior direito foi extraído e a mucosa gengival suturada com fio de algodão. Decorridas 72 horas, a mesma antissepsia foi repetida e o fio de sutura removido e encaminhado ao laboratório de microbiologia para avaliar o crescimento de bactérias aeróbicas e anaeróbicas . No Grupo II (soro fisiológico), todos os procedimentos foram semelhantes, com exceção de antissepsia que foi simulada com soro fisiológico. No Grupo III, tanto a extração quanto a remoção do fio de sutura foram realizadas sem o emprego de nenhuma substância antisséptica. Além da análise microbiológica, a maxila direita foi removida e, após processamento laboratorial de rotina, incluídas em parafina para possibilitar a microtomia. Os cortes foram corados pelo método de Gram para tecidos e pela hematoxilina e eosina para estudo microscópico. Os resultados indicam que: 1) o emprego da clorexidina ocasionou uma diminuição significativa da contaminação bacteriana na superfície do fio de sutura, no ato de sua remoção; 2) a antissepsia com clorexidina possibilitou uma neoformação fibroblástica e capilar precoce no alvéolo dental quando comparado aos demais grupos.

Estudo da translocaçäo bacteriana após sutura primária de colo com e sem limpeza mecânica: trabalho experimental em cäes / Bacteria translocation study after primary colocolonic suture with and without mechanical purging in dogs

O objetivo do presente trabalho foi investigar a ocorrencia de translocaçäo bacteriana em cäes submetidos a suturas colocólicas primárias, no colo descendente, com e sem limpeza intestinal. Para o estudo, foram utilizados três grupos de oito animais. O Grupo I (obs. de 1 a 8) foi utilizado como grupo-controle. Nesse grupo, os animais foram submetidos à laparotomia sob anestesia geral, exposiçäo das alças intestinais ao ar ambiente da sala cirúrgica pelo período de cinco minutos. No Grupo II (obs. de 9 a 16), realizou-se colotomia e sutura colocólica primária, sem limpeza do conteúdo cólico e fechamento da parede abdominal. No Grupo III (obs. de 17 a 24), realizou-se colotomia, limpeza do reto, limpeza do colo por meio de lavagem mecânica transoperatória retrógrada, seguida de sutura colocólica terminoterminal e fechamento da parede abdominal. Todos os animais foram mantidos em observaçäo pelo período de 24 horas. Após esse período foi realizada a coleta de amostras de sangue e amostras de linfonodo mesentérico, do fígado, baço, rim e pulmäo para realizaçäo de culturas. As culturas foram realizadas em meios específicos para Escherichia coli e Enterococcus faecalis. Os resultados foram: näo ocorreu translocaçäo bacteriana para o sangue portal nos Grupos II e III. Ocorreu translocaçäo bacteriana para os linfonodos, fígado, baço, rim e pulmäo nos Grupos II e III. Observaram-se índices de translocaçäo bacteriana mais elevados no Grupo II do que no Grupo III, porém sem significância estatística. A Escherichia coli foi a bactéria isolada nas culturas positivas dos Grupos II e III